Protocol for the Request of Knee Magnetic Resonance Imaging in Elderly Patients with Suspected Osteoarthritis: Reduction in Test Requests and Impact on Management and Diagnosis

Arliani, Gustavo Gonçalves; Vergara, Juliana Munhoz; Mesquita Júnior, Isaias Duarte; Oliveira, Victor Otávio; Lara, Paulo Henrique Schmidt; Ferreira, Gabriel Ferraz

doi:10.1055/s-0040-1722576

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Revista Brasileira de Ortopedia

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Sumário

Original Article • Rev. bras. ortop. 57 (3) • 2022 • https://doi.org/10.1055/s-0040-1722576 copy

Protocol for the Request of Knee Magnetic Resonance Imaging in Elderly Patients with Suspected Osteoarthritis: Reduction in Test Requests and Impact on Management and Diagnosis^* * Study developed at the Orthopedics and Traumatology Department, Instituto Prevent Senior, São Paulo, Brazil.

Authorship SCIMAGO INSTITUTIONS RANKINGS

Abstract

Objective

To develop an evidence-based protocol to guide magnetic resonance imaging (MRI) requests in elderly patients with suspected knee osteoarthrosis and to evaluate its effectiveness after implementation.

Methods

The institutional protocol was developed after reviewing the literature during the first semester of 2018. The control group was defined as patients cared for in the first semester of 2018, before the implementation/dissemination of the institutional protocol, and the study group was composed by patients cared for during the second semester of 2018 after the standardization of MRI requests for suspected knee osteoarthrosis.

Results

Our sample included 826 patients undergoing knee MRI, with a mean age of 69.3 years. Protocol implementation decreased MRI requests and increased radiograph requests (p < 0.001). After the implementation of the protocol, the MRI changed the diagnosis or treatment in only 11.2% of the cases.

Conclusion

Protocol implementation resulted in a 47.5% reduction in the number of requests for knee MRI, with most (89%) patients with alteration in diagnosis or treatment. Level of evidence: case-control study (IIIB).

Keywords
osteoarthritis, knee; magnetic resonance imaging; clinical protocols

Characteristic	Before the protocol	After the protocol	p-value
Age	69.3 (7.6)^{^*}	69.4 (7.9)^{^*}	0.62
Gender	Female = 73.7% Male = 26.3%	Female = 69.1% Male = 30.9%	0.34
Dominant side	Right = 50.5% Left = 49.5%	Right = 44.7% Left = 55.3%	0.22
Was a radiograph requested before the magnetic resonance imaging scan?	Yes = 23.9% No = 76.1%	Yes = 47.1% No = 52.9%	p < 0.001
Did the magnetic resonance imaging scan change the conduct or diagnosis?	Yes = 13.8% No = 86.2%	Yes = 11.2% No = 88.8%	0.30

Sociedade Brasileira de Ortopedia e Traumatologia Al. Lorena, 427 14º andar, 01424-000 São Paulo - SP - Brasil, Tel.: 55 11 2137-5400 - São Paulo - SP - Brazil
E-mail: rbo@sbot.org.br

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[1] Address for correspondence Gabriel Ferraz Ferreira, MD, MSc, Orthopedics and Traumatology Department, Instituto Prevent Senior, Rua Cerro Corá, 585, Sala 605, Torre 1, São Paulo, SP, Brazil (e-mail: gabriel.ferraz38@yahoo.com.br).

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Protocol for the Request of Knee Magnetic Resonance Imaging in Elderly Patients with Suspected Osteoarthritis: Reduction in Test Requests and Impact on Management and Diagnosis* * Study developed at the Orthopedics and Traumatology Department, Instituto Prevent Senior, São Paulo, Brazil.

Abstract

Objective

Methods

Results

Conclusion

Protocol for the Request of Knee Magnetic Resonance Imaging in Elderly Patients with Suspected Osteoarthritis: Reduction in Test Requests and Impact on Management and Diagnosis^* * Study developed at the Orthopedics and Traumatology Department, Instituto Prevent Senior, São Paulo, Brazil.